Valve Replacement Surgery Cost in India

What is Valve Replacement Surgery Cost in India?

Heart valve replacement surgery is the second most common type of heart surgery after coronary artery bypass graft surgery (CABG) with the total number of surgical heart valve procedures performed in India being around 30,000 annually.

The average cost of valve replacement surgery in India ranges between INR 3,50,000 and INR 5,00,000 for Indian patients. For international patients, the cost ranges between USD 8000 and USD 11000. This cost includes the price of the prosthetic valve, surgeon fees, anaesthesia charges, OT charges, medical consumables, and a hospital stay for 3-7 days.

What is Valve Replacement Surgery?

Heart, the major blood-pumping organ of the body, is composed of cardiac muscles. The coordination between these cardiac muscles and electrical signals is responsible for pumping blood among the chambers and then throughout the body.

The heart is composed of four chambers, one on each side of the heart- two atria (upper chambers) and two ventricles (lower chambers). In between these chambers, flaps-like structures are present. They regulate the speed of blood flow and also prevent its backflow. The four valves present in the heart are as follows:

• Tricuspid valve: It controls the blood flow from the right atrium to the right ventricle.
• Pulmonary valve: It controls the blood flow from the right ventricle to the pulmonary artery.
• Mitral valve: It controls the blood flow from the left atrium to the left ventricle.
• Aortic valve: It controls the blood flow from the left ventricle to the aorta. 

Any damage caused in any of the valves can’t be repaired itself and usually gets worse with time and age. It is generally accompanied by symptoms such as

• Chest pain
• Shortness of breath
• Fatigue
• Heart palpitations 
• Abnormal blood pressure
• Swelling in leg

Some common heart disorders associated with the valves are as follows:

• Valve regurgitation: 

This condition arises when the valve doesn’t close properly and there is backward flow of the blood into the chamber. Since there is leakage of blood, this condition is also referred to as a leaking heart valve. 

• Stenosis: 

Stenosis occurs when a valve’s leaflets get thick or stiff or stick together due to deposition of cholesterol. As a result of this, the valve doesn’t open to its full extent and doesn’t pump the blood efficiently.

• Atresia: 

This is a congenital condition in which the valvular cusps are fused at birth, limiting blood flow. The two significant types of atresia are pulmonary atresia and tricuspid atresia, which occur in the pulmonary and tricuspid valves, respectively.

• Prolapse

In this condition, the valve flaps become highly flexible and stretched out. They bulge backward like a parachute, thus unable to control backflow of the blood. This condition can also lead to leakage of blood.

When the valve doesn’t open or close correctly, affecting the way the heart functions, cardiac surgeons perform valve replacement surgery. In this, the damaged valve is replaced with a prosthetic valve. The prosthetic valve can either be mechanical or biological.

Mechanical Valves: These are made from artificial materials, usually metal. They are durable and can last a lifetime without needing replacement. However, patients with mechanical valves need to take blood-thinning medication such as anticoagulants for the rest of their lives to prevent blood clots. The benefits include longevity and durability, reducing the need for frequent surgeries.

Prosthetic Valves: These are made from biological tissue or animal valves ,usually from pigs or cows. It doesn’t require lifelong blood-thinning medication. However, they may wear out over time and need to be replaced. The benefits include not needing blood-thinners and often having a lower risk of blood clots compared to mechanical valves.

What are the Types of Valve Replacement Surgery?

Based on the valve which has been damaged, the valve replacement surgery has been categorised into the following:

Aortic valve replacement

The aortic valve is a tricuspid valve, and any complication associated with it is mostly congenital. In a bicuspid aortic valve, only two leaflets are formed at birth, making it a defective bicuspid valve. The valve doesn't open and close properly, thus leading to leakage and backflow of blood. 

To treat this condition, cardiac surgeons replace the damaged aortic valve with a prosthetic one. Depending on the patient's needs, this replacement valve could be mechanical or biological.

Mitral Valve Replacement

The mitral valve is a bicuspid valve on the left side of the heart. It controls flow of blood from the left atrium to the left ventricle. Any insufficiency associated with blood flow passing through this valve should be immediately checked and treated.

To address this condition, cardiac surgeons undertake a procedure to replace the impaired mitral valve with a prosthetic alternative. 

Double Valve Replacement

Sometimes, a patient has two damaged heart valves, which subsequently limit the overall blood flow in the heart. The valves usually involve the aortic and mitral valves. 

Double valve replacement is a surgical intervention in which both the aortic and mitral valves are replaced to mitigate problems caused by improper blood flow. This procedure becomes necessary when conditions like severe aortic stenosis or regurgitation, coupled with significant mitral valve disease, impair the heart's ability to pump blood efficiently. 

Pulmonary Valve Replacement

The pulmonary valve is responsible for regulating flow of blood from the right ventricle to the pulmonary artery, which transports deoxygenated blood to the lungs for oxygenation. The most common complication associated with pulmonary valve is stenosis (narrowing) or regurgitation (leakage). 

Pulmonary valve replacement involves removing the damaged pulmonary valve and inserting a prosthetic valve, either mechanical or biological tissue, to restore normal blood flow.

More than 40 million people are living with either mitral or aortic valve disease worldwide. A cardiac surgeon utilises either an open surgery or a minimal invasive approach to replace the damaged valve with a prosthetic one.

What are the Key Factors That Affect the Valve Replacement Surgery Cost in India?

Understanding the cost factors associated with valve replacement surgery helps patients and their families avoid financial strain or unexpected expenses associated with the surgery. It allows them to plan ahead, explore cost-saving strategies, and mitigate the risk of financial strains resulting from medical bills or healthcare expenses.

Here, the key factors affecting the valve replacement cost in India are listed below.

Type of prosthetic valve used

The cost associated with the valve replacement surgery procedure may vary based on the selection of valve type, including options like mechanical valves or biological valves. Some valves may be expensive due to their specific design (self expandable or balloon expandable), materials (mechanical or biological), or technological features involved to create it. 

The cost of mechanical valve for Indian patients is INR 1,00,000 and for international patients, it is USD 2500. Biological valve is comparatively costly, which is INR 1,50,00 for Indian patients , whereas, for international patients, it is USD 3000. 

Hospital location

The hospital's location and its distance from major cities may increase the cost. Hospitals in metropolitan areas usually have higher overhead costs, which reflects in the final cost.

Additional stay at hospital/ICU

In certain medical complexities, the patient may have to stay for some extra days in the hospital or ICU for post-operative care. Thus, the additional hospital stay costs around INR 12,000 and INR 20,000 (USD 200 to USD 300) on a per day basis.

What are Pre-surgical and Post-surgical Expenses in Valve Replacement Surgery?

Before undergoing valve replacement surgery, cardiac surgeons recommend various tests and examinations to understand the extent of the damage caused to the valve and then decide whether it could be repaired or need a replacement. It is also important to see whether the patient is ready for the surgical procedure or not.

After the valve replacement surgery, follow ups are necessary to ensure that the prosthetic valve is functioning properly and there is no further damage. These expenses should also be considered by the patients and their family.

• Pre-surgical examination cost (complete blood count, electrocardiogram, echocardiogram, coronary angiography, CT scan, nuclear stress test etc.): INR 15,000 to INR 20,000 (USD 250 to USD 300)
• Post-surgical cost (follow-up consultations and medications): INR 3,000 to INR 4,000 (USD 50 to USD 100)

What should be Post Valve Replacement Surgery Care?

Since a prosthetic one replaces the naturally present valve, it's essential to monitor any infection and the efficiency of the performance of the replacement valve. Other potential complications, such as bleeding, infection, etc., should never be ignored. The success of the valve replacement surgery and the patient's overall well-being depends significantly on the post-operative care they receive. Some of the measures for post-valve surgery care are as follows:

Follow Medical Advice

After valve replacement surgery, patients must strictly adhere to their healthcare provider's instructions. This includes taking prescribed medications, attending follow-up appointments, and following any dietary or activity restrictions recommended by their doctor.

Activity limitations

It is advised to limit strenuous activity, such as heavy lifting or gym exercise, during the initial recovery period to allow the body to adjust to the changes and heal properly.

Monitor for Infections

Some patients may suffer from prosthetic valve endocarditis in which infection-causing bacteria reach the prosthetic valve via the bloodstream. Normal heart valve tissue is naturally resistant to such infections. However, diseased valves have defects that make it easier for infections to occur. This can be treated with a course of antibiotics for around six weeks. Any discomfort should be immediately reported to the doctor. 

Attend Cardiac Rehabilitation 

Cardiac rehabilitation programs are designed to help patients recover from heart surgery and improve their cardiovascular health. These programs typically include supervised exercise sessions and a guided diet plan. They significantly enhance recovery and reduce the risk of future heart problems.

Does Insurance Cover Valve Replacement Surgery in India?

Insurance agencies in India cover heart surgeries procedures which include Valve Replacement Surgery as well . After consulting your cardiac surgeon, you have to submit your doctor’s prescription, investigation reports and hospital documents to the insurance agency along with the policy papers. Then, they will check whether you are eligible for the claim or not. After all the required paperwork has been processed and approved, the insurance agency will then coordinate with the hospital to ensure the covering of medical expenses as per policy terms.

Generally, health insurance policies may cover a portion or all of the expenses associated with valve replacement surgery. This includes the price of the prosthetic valve, hospitalisation, surgeon fees, pre-operative tests, and post-operative care.